Free Mercy by Daniel Palmer

endure it.
    Ashley looked deeply troubled. “Dr. Devereux, what exactly are you doing?”
    The constant motion of the ambulance made it difficult to hold the needle in the proper place. The screech of the siren pounded at Julie’s eardrums.
    “He’s bleeding into the pericardial sac surrounding the heart,” Julie said. “It’s compressing his atrium and backing the blood up into his veins.”
    Being an experienced paramedic, Ashley understood right away what Julie planned to do.
    “You’re going to perform a pericardial tap? Here? Now?”
    “He’s got cardiac tamponade. If I don’t do it, he’ll die.”
    There was no real test for cardiac tamponade, though echocardiography had improved the diagnosis considerably. A process of elimination and a gut feeling had brought Julie to this moment.
    The needle trembled ever so slightly in Julie’s typically steady hand. Fear was foreign to her when it came to performing life-saving medical procedures, but Ashley was right to be concerned. In terms of risky maneuvers, this one, under these conditions, ranked near to the top. Sam should be in the ICU. He should be given more oxygen, plasma volume expansion with an infusion of blood or dextran. To do this properly, Julie should take between twenty minutes and an hour. Now, she had but seconds.
    Most of the color had drained from Ashley’s face. “We’re not authorized to perform this procedure,” she said.
    “Yeah, well, I am.”
    The needle was attached to a plastic grip that fit comfortably in Julie’s hand. Julie’s fingertips rested at the tip of the needle, increasing her dexterity and control. She inhaled deeply and exhaled through her nose.
    You can do this … for Sam … you can do this …
    Julie twisted the needle back and forth and pushed hard enough to puncture the skin. A trickle of blood oozed out from tiny gaps around the circumference of the needle. Julie took in another readying breath and visualized the anatomy. If she didn’t get this right, the needle could puncture the heart or liver, or collapse a lung.
    “Bill, pull to the side of the road!” Ashley called out.
    “No! Keep driving! I’ve got this.”
    “What do you want me to do?” asked Bill, who took his orders from Ashley.
    Ashley locked eyes with Julie. “Keep going,” Ashley said.
    In one quick thrust, Julie drove the needle up toward Sam’s left shoulder. But that was only step one.
    “I need a syringe. Again, the biggest you’ve got.”
    The syringe Ashley handed her—twenty milliliters, not quite the size Julie wanted—screwed onto the plastic grip. Julie released a flange, and built-up pressure in Sam’s pericardium pushed blood into the syringe at a rate much higher than Julie anticipated.
    “I need another syringe, stat!” Julie yelled.
    Blood quickly filled the syringe, but more was coming. Pressure steadily built up inside the syringe, and Ashley reached for a replacement. Too slow. With a popping noise, the plunger damming the blood shot from the syringe barrel like a bullet from a gun. A jet of dark blood exploded in a horizontal geyser that covered Julie’s face in red. Blood splattered on her clothes, her neck, face, and hair.
    Ashley gasped in horror as Julie reached for the flange to shut off the blood flow. With the back of her hand, Julie smeared more of Sam’s blood across her face as she wiped her eyes clear. The coppery, metallic taste soiled her mouth and turned her stomach.
    “Blood pressure is rising and I have a good pulse,” Ashley said, her voice calm in spite of all the blood. “Heart rate is coming down, too.”
    “I need another syringe,” Julie said, breathless. A trickle of blood dripped off her chin and left dots on the floor by her feet.
    “Heart rate is one oh six, one hundred … goodness, it’s down to ninety.”
    Julie got the second syringe in place. This time, as she opened the flange to allow blood flow again, she kept her hand on the plunger to control the pressure. Blood